title: Design and baseline data from the Management of Sadness and Anxiety in Cardiology (MOSAIC) randomized controlled trial.
abstract: BACKGROUND
  Depression and anxiety in cardiac patients are independently associated with adverse cardiovascular outcomes, including mortality. Collaborative care (CC) programs, which use care managers to assess patients, coordinate care, and perform therapeutic interventions, have proven effective in managing depression in this population. However, no prior CC intervention has simultaneously managed depression and anxiety disorders, and there has been minimal study of CC in high-risk cardiac inpatients.
  
  
  METHODS
  The Management of Sadness and Anxiety in Cardiology (MOSAIC) study was a prospective randomized trial of a low-intensity CC intervention, compared to enhanced usual care, for patients hospitalized for acute coronary syndrome, heart failure, or arrhythmia, and diagnosed with depression, generalized anxiety disorder (GAD), or panic disorder (PD). The primary outcome measure for MOSAIC was mental health-related quality of life (HRQoL), measured using the Medical Outcomes Study Short Form-12. Additional outcomes included psychological, functional, and medical outcomes, including rehospitalizations.
  
  
  RESULTS
  A total of 183 eligible participants were enrolled (92 collaborative care, 91 enhanced usual care); 94% of depressed patients reported being depressed for >1month, and 53% of those with GAD reported clinically significant anxiety for >1year. One hundred thirty-three patients had depression, 118 had GAD, and 19 had PD; 74 participants (40%) had two or more of the disorders.
  
  
  CONCLUSIONS
  The MOSAIC trial will provide data regarding whether an intervention that concurrently manages these common psychiatric disorders results in meaningful improvements in HRQoL, psychiatric symptoms, and medical outcomes in cardiac patients at high risk for adverse outcomes.
authors.affiliation: Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States. Electronic address: jhuffman@partners.org.
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Huffman
authors.forename: Scott R
authors.initials: SR
authors.lastname: Beach
authors.forename: Laura
authors.initials: L
authors.lastname: Suarez
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mastromauro
authors.forename: Christina M
authors.initials: CM
authors.lastname: DuBois
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Celano
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Rollman
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000523:psychology; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000523:psychology; D003299:Cooperative Behavior; D003863:Depression / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D006331:Heart Diseases / Q000523:psychology*; D006333:Heart Failure / Q000150:complications / Q000523:psychology; D006801:Humans; D016584:Panic Disorder / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D010348:Patient Care Team; D011613:Psychotherapy / Q000379:methods; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents
keywords: Anxiety; Arrhythmia; Collaborative care; Coronary artery disease; Depression; Heart failure